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Anticoagulant Not Restarted After Amputation; No Causation Shown


A 69-year-old woman was admitted to the hospital for treatment of a gangrenous left foot. The woman was administered an anticoagulant, Heparin. After initial medical treatment and procedures failed, the woman’s treating physician consulted with a surgeon about amputating the woman’s left leg below the knee. Prior to the amputation the Heparin was discontinued. The surgeon performed the amputation. After the procedure, while in the hospital, the woman went into respiratory and cardiac arrest and died.

 

The woman’s estate filed a medical malpractice claim against the surgeon and the surgeon’s practice group. The complaint alleged that the woman’s death was the result of a pulmonary embolus that was caused by the surgeon’s failure to restart the administration of an anticoagulant after the amputation.

 

The surgeon and the practice group moved for summary judgment. The motion argued that the estate failed to present evidence of causation. The motion asserted that the evidence conclusively proved that the surgeon was not negligent and that the surgeon’s actions were not the cause of the woman’s death.

 

The estate responded by submitting expert testimony. The estate’s expert testified that it was possible that the woman’s death was caused by a pulmonary embolism, but that it may also have been caused by cardiac arrhythmia or myocardial infarction. In response to a question regarding the factual basis for the opinion that a pulmonary embolus was the most probable of the three possibilities, the estate’s expert replied, “I have no facts—an autopsy wasn’t done, so there is no way to testify precisely what killed [the woman].” The estate’s expert went on to say there was no support in the woman’s medical records that the woman had a pulmonary embolus and that the estate’s expert did not eliminate cardiac arrhythmia or myocardial infarction as probable causes of the woman’s death. The estate’s expert then testified that assuming a pulmonary embolism did cause the woman’s death, the estate’s expert had no evidence that the anticoagulation would have prevented a pulmonary embolism. The estate argued that the expert’s testimony demonstrated causation and defeated the no-evidence motion.

 

The 240th District Court of Fort Bend County granted summary judgment in favor of the surgeon and the surgeon’s practice group.

 

The First District Court of Appeals of Texas, Houston, affirmed. The court held that the estate failed to present evidence that showed there was a reasonable medical probability that the surgeon’s alleged negligence—failing to re-prescribe anticoagulants—proximately caused the woman’s death.

 

The estate failed to present evidence that showed there was a reasonable medical probability that the surgeon’s alleged negligence—failing to re-prescribe anticoagulants—proximately caused the woman’s death. The estate’s expert’s testimony did not raise a fact issue regarding causation. The estate’s expert offered possibilities as to cause of death, admitted that no evidence showed that the use of anticoagulants would have prevented the woman’s death, and failed to show that any action taken or not taken by the surgeon was the cause of the woman’s death. The estate’s expert testified that it was possible that the woman’s death was caused by a pulmonary embolism, but failed to eliminate the other two plausible causes of the woman’s death. The estate’s expert also testified that even if the woman’s death was caused by a pulmonary embolism, there was no evidence that restarting an anticoagulant after the surgery—which the estate alleged was the surgeon’s negligent act—would have prevented the woman’s death. Further, the estate’s expert could not say when an alleged blood clot formed; such a clot could have formed at a time after which resuming the use of anticoagulants would not have helped. The estate’s expert’s testimony did not show to a reasonable medical probability that the surgeon’s alleged negligence was a substantial factor in causing the woman’s death.

 

The First District Court of Appeals of Texas, Houston, affirmed the trial court’s grant of summary judgment in favor of the surgeon and his practice group.

 

See: Kyle v. Hillery, 2018 WL 1003807 (Tex.App.-Hous. (1 Dist.), February 22, 2018) (not designated for publication).

 

See also Medical Law Perspectives Report: Thicker Than Water: Liability When Blood Clots Cause Injury or Death

 

See also Medical Law Perspectives Report: Drugs, Dosage, and Damage: Physician Liability for Prescribing or Administering Medication

 

 

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